Had IVF ICSI. E2 and Progesterone levels are okay but low BHCG. No ectopic pregnancy. Chances of getting pregnant?

Had IVF ICSI (first time-40 yrs old). Normal day 5 blastocyst were transferred on the 19th of February. E2 and Progesterone levels are okay but BHCG levels are very low and slow. Day 11 is 34.5, Day 13 = 34.2, Day 15 45.8, Day 16 = 61.3; Day 19=242 and Day 21 = 381. Had an early ultrasound with another Doctor at Day 20 and no sign of ectopic pregnancy but nothing has been seen by the doctor so far. She said there is a very small thing but she cannot say what it is. She saw fibroids which were not there last time she did an ultrasound to me(January). No tubes are clear. No other issues. Today is Day 21, no pain, no bleeding, just extreme paranoia, bloated stomach and cramps on hips. IVF Clinic called me (Day 21) and instructed me to stop medicines (hormones) . BHCG is too slow and tomorrow will be ultrasound. I do not expect that they will see a big difference from what was seen on Day 20 and I'm afraid they will say that the cycle is failed and that I will be asked to let go. Can you please comment on my development and how should I react to my expected advise from the IVF Clinic. My paranoia started from what I have been hearing from the nurses and from what I have been reading in the internet. Too low BHCG level is a failed pregnancy and that will lead to miscarriage.It can also be a sign of ectopic pregnancy. Should I still ask for more days from the IVF clinic? Is there a risk for keeping it and keep some hopes for at least a week more? Or it is really a doomed pregnancy?

1) Beta hCG values should double every 48 hours which has not happened in your case. Though there is late rise in the levels, it is not doubling. Hence it is possible that you have had a biochemical pregnancy ( detected in blood test only but not on ultrasound).

2) You IVF centre has adviced you to stop medicines as they are also thinking as I told you. Hence probably pregnancy is not viable.

3) I understand its devastating news. But you have to slowly accept it.

4) Alternatively, you can continue the medicines for another 2 days and check beta hCG again to check doubling value. There is no harm in continuing medicines if you wish to.

5) Fibroids might have been missed by your doctor in earlier scans and diagnosed now. Not to worry much about it.

6) There is no risk for keeping the pregnancy and continuing medicines. You can ask for more time from your clinic.

I hope I answered your query. I will be available for any followup queries you have.

Follow-up: Had IVF ICSI. E2 and Progesterone levels are okay but low BHCG. No ectopic pregnancy. Chances of getting pregnant? 2 hours later

Hello Dr. Koregol,

Your answers are very clear.

If I will decide to keep the pregnancy and continue to live with it as long as I feel okay, do you think I should continue going for blood tests to monitor my hcg level and go to another doctor to do a scan again?

What symptoms should I look for or be aware of to make sure that I am not running my life at risk? (I might be developing ectopic pregnancy without knowing it...that's a possibility right?) I just want to know so at least I would know when I should go for immediate help. The moment that I ask for more time from the IVF Clinic, I would think that I am bearing all the risks or consequences of all my decisions.

Is there something that you can advise that I should do regarding caring of myself that can help in keeping my pregnancy?

I have extra embryos (Day 6) frozen. Will these still be okay for implantation? No genetic testing was done for these embryos (blasts) because since the first two (day 5) were genetically tested (PGD) and they are okay, we hoped and believed that the other blasts are okay. Do you think it makes sense? Or should we do another PGD for the the extras?

When is the best time to try again?

Thank you.

Answered by Dr. Mahesh Koregol 7 hours later

answer Id 157079; conversation id 155145

Hi XXXXXXX I know you desperately wush to continue pregnancy. Following is my reply : 1) Continuing as long as you wish wont harm. But the medicines you will be taking are not good. Many progesterone suppliments are unnecessary if you dont have viable pregnancy. Hence stop medicines and wait. If you dont have viable pregnancy, you will get periods. If pregnancy is good ( which is less likely) you wont get periods. 2) Signs of ectopic pregnancy are pain abdomen, bleeding per vagina. If you get any of these, please see the clinic. 3) I dont think it is wise to continue beyond one week. Get tested for betahCG after a week and if values have noy risen stop medicines and wait for periods. There is not much use of going to another clinic. 4) You already havd frozen blastocysts. Hence, you can take another chance in next cycle. No need to do PGD on them as they might destroy embryos while doing PGD. They will be good only as previous ones were good. 5) You can get frozen embryo transfer after 2 or 3 months. I hope I answered your query. I will be available for the follow up query you have. Regards, Dr. Mahesh Koregol

Follow-up: Had IVF ICSI. E2 and Progesterone levels are okay but low BHCG. No ectopic pregnancy. Chances of getting pregnant? 33 hours later

Hello again Doctor,

Did an ultrasound at Day 22, no sac found. Another Bhcg test today, Day 23, result is 461. Doctor advised that it may be a tubal pregnancy and an official scan will be done on Day 25.

According to Wikipedia, "Mortality of a tubal pregnancy at the isthmus or within the uterus (interstitial pregnancy) is higher as there is increased vascularity that may result more likely in sudden major XXXXXXX hemorrhage". If it is a suspected tubal pregnancy, why do we need to wait for two days before something is done to me? Do we really need to wait for pain to occur before we say that it is ectopic?

What is the normal procedure after knowing that a patient is having an ectopic pregnancy?

1) Possibility is that it could be a delayed slow rise of beta hCG value which is also possibility.

2) Ectopic pregnancy has to be diagnosed by ultrasound or by performing laparoscopy . Ultrasound is not always diagnostic and difficult to see ectopic sac. Hence your doctor is not sure. Laparoscopy is invasive surgery hence dotor is watching you.

3) When diagnosis is not sure, your doctor is waiting to make final decision which is fine.

4) If you get pain abdomen or bleeding per vagina, please rush to hospital. Till then is ok to wait.